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Paper Chase #5 | Unnecessary Transfers To The ED

Nate Finnerty, MD and Brett Ebeling, MD
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In this retrospective, single center study most patients transferred to the emergency department from an urgent care center were discharged, and many transfers were considered unnecessary. However, their definition of unnecessary transfers may exclude many patients who were appropriately transferred from the urgent care.

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Tabor D., PA-C -

The inability to check a troponin or d-dimer in the urgent care is unfortunately the deciding factor for me. If we cannot adequately rule-out a life threatening cardiac/PE cause for active chest pain with objective data like labs, then I do not take the risk and always send the patient to the ED. I trialed ordering a stat lab through our lab service, but I ultimately ended up having to take calls from the lab at home after the urgent care closed and the results were reported several hours later. In addition, I then would have to call the patient from home to close the loop for follow up and notify about labs. So at the end of the day it is currently safer and more logistically efficient to send the patient to the ER. I'm fine with the ED thinking it's an inappropriate transfer, I'm not fine with putting any patients at risk 2nd to not being able to get labs in a timely manner. I really appreciate this podcast it has been very helpful in my personal practice.

Mike W., MD -

Yes you are right, if you cannot get a troponin, you lose much of your ability to exclude MI/ACS and the pt will need to be transferred to the ED. Completely agree! Thx for the comments!!

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The Blood Meals Full episode audio for MD edition 207:18 min - 97 MB - M4AHippo UC RAP July 2018 Written Summary 364 KB - PDF

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